{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T16:40:16Z","timestamp":1793032816065,"version":"4.5.0"},"reference-count":22,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR202869"],"award-info":[{"award-number":["NIHR202869"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Childbirth\u2010related perineal trauma (CRPT) is the most common complication of vaginal birth, yet its associations with mental health and other health outcomes remain poorly described. This study examined the annual incidence of recorded CRPT by tear degree and investigated its association with mental health and other health outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using Clinical Practice Research Datalink Aurum primary care data linked with Hospital Episode Statistics, including women aged \u226516\u2009years who had given birth vaginally between 1st January 2005 and 31st December 2019. Exposure was defined as recorded CRPT of any degree including episiotomy. Annual incidence of CRPT was calculated as a percentage of all births. Cox proportional hazards regression models compared short\u2010, medium\u2010, and long\u2010term (&lt;1\u2009year, 1\u20135\u2009years, and &gt;5\u2009years post\u2010childbirth) outcomes between women with and without CRPT. We conducted subgroup analyses by degree of tear and in women with spontaneous vertex births, and a sensitivity analysis restricted to first birth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Incidence of recorded CRPT increased from 43.4% to 48.8% between 2005 and 2019. Compared to women without CRPT, those with CRPT had a higher risk of anxiety (aHR 1.19, 95%CI 1.17, 1.22) or depression (aHR 1.23, 95%CI 1.21, 1.25) within 1\u2009year postpartum, with elevated risks persisting beyond 5\u2009years and across all degrees of tear. Women with 1st\/2nd degree tears or episiotomy had a higher hazard of post\u2010traumatic stress disorder 1\u20135\u2009years postpartum. CRPT was associated with increased hazard of urinary incontinence, dyspareunia, reduced libido, vaginal discharge, general and perineal pain, and prolapse in all follow\u2010up periods. Fecal incontinence was increased in women with episiotomy or 3rd\/4th degree tears, persisting long\u2010term for severe tears. CRPT was associated with 32% higher risk of antibiotic prescription compared to no CRPT (OR 1.32, 95%CI 1.30, 1.33) within 6\u2009weeks postpartum.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Recorded CRPT was associated with increased risks of diagnosed anxiety and depression in short\u2010, medium\u2010 and long\u2010term post\u2010childbirth, irrespective of tear severity, as well as higher risks of other adverse outcomes, including urinary incontinence, pain, and sexual dysfunction. Addressing CRPT should be prioritized to improve women's health and well\u2010being.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aogs.70320","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T05:26:11Z","timestamp":1784265971000},"page":"2325-2342","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Childbirth Acquired Perineal Trauma (\n                    <scp>CHAPTER<\/scp>\n                    ) study: A cohort study investigating health outcomes after childbirth\u2010related perineal trauma"],"prefix":"10.1111","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3145-6185","authenticated-orcid":false,"given":"Zhaonan","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Applied Health Sciences University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luyuan","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0983-7590","authenticated-orcid":false,"given":"Rebecca","family":"Man","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0434-2158","authenticated-orcid":false,"given":"Christine","family":"MacArthur","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1247-429X","authenticated-orcid":false,"given":"R. Katie","family":"Morris","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences University of Birmingham  Birmingham UK"},{"name":"Birmingham Women's Hospital  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6816-1279","authenticated-orcid":false,"given":"Krishnarajah","family":"Nirantharakumar","sequence":"additional","affiliation":[{"name":"National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre  Birmingham UK"},{"name":"Department of Population Health Sciences King's College London  London UK"},{"name":"Health Data Research UK (HDRUK)  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0984-5830","authenticated-orcid":false,"given":"Arturo","family":"Gonzalez\u2010Izquierdo","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9817-4313","authenticated-orcid":false,"given":"Victoria Hodgetts","family":"Morton","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences University of Birmingham  Birmingham UK"},{"name":"Birmingham Women's Hospital  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0543-3254","authenticated-orcid":false,"given":"Nicola J.","family":"Adderley","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences University of Birmingham  Birmingham UK"},{"name":"National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"CHAPTER Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-13-59"},{"key":"e_1_2_13_3_1","unstructured":"NHS Digital.NHS Maternity Statistics 2018\u201319.2019. Accessed July 7 2026.https:\/\/digital.nhs.uk\/data\u2010and\u2010information\/publications\/statistical\/nhs\u2010maternity\u2010statistics\/2018\u201019"},{"key":"e_1_2_13_4_1","unstructured":"NMPA Project Team.National Maternity and Perinatal Audit: Clinical Report 2019. Based on births in NHS maternity services between 1 April 2016 and 31 March 2017.2019. Accessed July 7 2026.https:\/\/maternityaudit.org.uk\/FilesUploaded\/NMPA%20Clinical%20Report%202019.pdf"},{"key":"e_1_2_13_5_1","unstructured":"Royal College of Obstetricians and Gynaecologists.The Management of Third\u2010 and Fourth\u2010degree Perineal Tears. Green\u2010Top Guideline No. 29.2015. Accessed July 7 2026.https:\/\/www.rcog.org.uk\/media\/5jeb5hzu\/gtg\u201029.pdf"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-91799-8"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2019.05.038"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2024.01.035"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-023-05950-6"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40359-023-01105-6"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-021-03158-6"},{"key":"e_1_2_13_12_1","unstructured":"National Institute for Health and Care Excellence.Postnatal care NICE guideline [NG194].2021. Accessed July 7 2026.https:\/\/www.nice.org.uk\/guidance\/ng194"},{"issue":"5","key":"e_1_2_13_13_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2024-086724","article-title":"Childbirth Acquired Perineal Trauma Study (CHAPTER): a UK prospective cohort study protocol","volume":"14","author":"Morton VH","year":"2024","journal-title":"BMJ Open"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyz034"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyx015"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/birt.12721"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318242b1f7"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2005.00818.x"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-032368"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-019-04044-2"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2019.02.005"},{"issue":"5","key":"e_1_2_13_22_1","article-title":"Understanding and addressing mental health stigma across cultures for improving psychiatric care: a narrative review","volume":"15","author":"Ahad AA","year":"2023","journal-title":"Cureus"},{"key":"e_1_2_13_23_1","volume-title":"Postpartum Depression","author":"Carlson K","year":"2024"}],"container-title":["Acta Obstetricia et Gynecologica Scandinavica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aogs.70320","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/aogs.70320","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aogs.70320","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T16:05:36Z","timestamp":1793030736000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/aogs.70320"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,16]]},"references-count":22,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.1111\/aogs.70320"],"URL":"https:\/\/doi.org\/10.1111\/aogs.70320","archive":["Portico"],"relation":{},"ISSN":["0001-6349","1600-0412"],"issn-type":[{"value":"0001-6349","type":"print"},{"value":"1600-0412","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,16]]},"assertion":[{"value":"2025-12-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}